Fragmented care. About 20 percent of US adults, who receive independent services from two or more providers for multiple chronic physical, mental and substance abuse conditions, account for nearly 50 percent of US health care spending. Fragmented care of patients with five or more chronic conditions accounts for more than 90 percent of Medicare spending. Fragmented care is so unsatisfactory, dangerous, ineffective, and costly that it threatens the US economy and the national debt. Paradoxically, at all income levels in the US, fragmented care is the rule and integrated care the exception. As a patient's frequency of co-occurring chronic conditions increases, so does fragmentation of the patient's care across multiple providers. In a single year, the typical Medicare beneficiary sees two primary care physicians and five specialists in four different practices, with no one provider accountable for the safety, quality and costs of the patient's care.
Gaps in patient care, for the purposes of this patent application are defined to mean poorly coordinated care of patients, resulting in needless danger and expense. For example, Dr. A prescribes penicillin for Patient X, even though Dr. B previously diagnosed Patient X as having an allergic reaction to penicillin. Or, Dr. C orders an MRI for Patient X, even though Dr. D ordered the same MRI one month ago. Or, Dr. E refers Patient X to Dr F for confirmation of a cancer diagnosis, but Dr. F's office refuses to schedule the appointment because Patient X is covered only by Medicaid.
Gaps in regulatory compliance are defined to mean misalignment of provider services with applicable regulations. For example, Dr. G is a Medicare provider covered by requirements for meaningful use of electronic health records but does not update Patient X's medication and allergy lists during an encounter for which he bills Medicare.
Electronic health records (EHRs). Conventional EHRs are defined as electronic versions of providers' medical record systems. Patients with many EHR-equipped providers, have many EHR records as well as opportunities for provider-to-provider misunderstandings, gaps in care, and diffusion of responsibility. Since 2001, the US has encouraged provider adoption of EHRs to make health care safer and more efficient. Despite the availability of incentives for meaningful use of EHRs to eligible professionals and hospitals from the Centers for Medicare and Medicaid Services (CMS), only a fraction of providers serving patients with chronic conditions are eligible for these incentives. Among those who are eligible, rates of EHR implementation are lowest among providers of care to chronically ill and disabled patients. The fragmented storage of patient data in unconnected paper files and EHRs exacerbates diffusion of responsibility for all patients, fostering gaps in care of the patients who frequently utilize health care services.
Personal health records (PHRs). PHRs are defined as electronic versions of patients' records of their own health information. Tethered PHRs (or patient portals) give patients partial online views of their information in the EHR of a practitioner, hospital or health insurance payer. Standalone PHRs reside on portable storage devices and require manual entry by patients of their own health information. The present invention involves a unique unbound, interoperable PHR Platfoi ii unlike tethered PHRs, not tethered to any one EHR, unlike standalone PHRs, capable of automatically consuming and integrating data from multiple EHR sources.
A personal health record (PHR) Platform is defined as a place to launch the programming logic so that the code will run consistently executing its intended capabilities described below.
Differentiating the PHR Platform from Conventional EHRs and Tethered PHRs
First, the Platform is distinguished from conventional EHRs and tethered PHRs by individualized patient hierarchies of user permissions embedded in the application layer, controlling disclosures of data to authenticated users through the presentation/transport layer. Users who properly identify themselves from web-connected and mobile devices (e.g., through login entries or tokens) are authenticated at the infrastructure layer by authorization records, matched with permissions in the application layer, and offered authorized disclosures of decrypted data through the presentation/transport layer. Firewalls and encryption prevent Platform access by authorized or unauthorized users beyond the presentation/transport layer. Patients or their delegates employ user interfaces in the presentation and transport layer (hereinafter “patient user interfaces”) to authorize providers they trust (hereinafter “primary providers”) with the highest level of user permissions including the capacity to authorize lesser permissions for other providers (hereinafter “secondary providers”), thereby establishing individualized patient hierarchies of user permissions for access to data in patient's PHRs.
Second, the Platform is distinguished by continuous scanning of data and application layers for gaps in patient care and by escalating alerts to users with suitable permissions. Programming logic in the infrastructure layer scans for gaps within and between data and application layers such as prescription of a drug to which a patient is allergic, or absence of results for a lab test for which the lab has been paid. Consistent with individualized patient hierarchies of user permissions, the presentation/transport layer pushes and escalates alerts to users' mobile devices, consistent with users' alert preferences, until several users confirm contributions to gap remediation.
Third, the Platform is distinguished by tagging of data elements with information about individualized patient hierarchies of user permissions, selectively filtering data disclosed to authorized users and impeding handoffs of data by authorized to unauthorized users. Programming logic in the infrastructure layer tags data elements stored in relational databases, identifying membership in data segments (such as physical health or mental health), associations with user permission hierarchies, data element sources and versions. Original and updated versions of data elements and their tags are stored permanently, subject to archiving from view in user interfaces but, barring patient requests, not to deletion. Programming logic relies on tags to assure that only permitted data (e.g., risk factors and physical health but not mental health or substance abuse) are disclosed to users through the presentation/transport layer. Embedded tags, akin to bar codes on physical objects, travel with data after export to authorized users, are difficult to remove and increase the risks and costs of improper handoffs and resale of patient data. Continuous auditing of user access to tagged data elements documents disclosures for patients, reducing overhead of providers associated with information exchange for referrals, transitions of care and care coordination.
Unique Advantages of the PHR Platform Compared to Conventional EHRs and Tethered PHRs
The PHR Platform offers a unique advantage, compared to conventional EHRs and tethered PHRs, for cross-provider care coordination without violation of individualized patient hierarchies of user permissions. From the presentation/transport layer of the Platform, in accordance with individualized patient user permission hierarchies, users may enter and update patient data including conditions, referrals, encounters, medications, recommendations, adverse reactions, and care plans. Patients, family caregivers and multiple providers may update patients' PHRs simultaneously (without waiting for one user to logoff before another user can login) or sequentially; manually through patient and provider user interfaces or automatically through exchanges of continuity of care documents with electronic health record systems (EHRs) or through web services; in point-to-point exchanges of one patient's data or in batch exchanges of many patients' data. Programming logic in the infrastructure layer of the Platform uses tags to recognize and consolidate new with existing data elements, to share comprehensive data with authorized users when they choose to access the Platform, and to push alerts to user's mobile devices, in accordance with individualized patient user permission hierarchies, about gaps in care that may needlessly endanger patient safety or waste resources. For example, an alert may be pushed out and escalated when a community-based provider fails to schedule an encounter within a week of a patient's discharge from hospital to his care. Or, an alert may be pushed out when a consultant orders tests duplicating tests ordered within the past month, the results of which are available in the patient's PHR. Alerts are escalated in accordance with the patient hierarchy of user permissions until the primary provider indicates remediation of the gap.
The PHR Platform offers a unique advantage, compared to conventional EHRs and tethered PHRs, for provider compliance with practice guidelines and government regulations without violation of individualized patient hierarchies of user permissions. Programming logic in the infrastructure layers uses tags on data elements to match patient data with practice guidelines and government regulations and to prompt providers for compliance in accordance with individualized patient user permission hierarchies. Providers receive prompts through the provider user interface in the presentation/transport layer, when for example, a medication list has not been updated as per Centers for Medicare and Medicaid Services (CMS) meaningful use requirements or when a patient over age 65 has not received a flu shot per CMS Clinical Quality Measure requirements. Continuous auditing in the infrastructure layer documents compliance with practice and regulatory requirements together with exceptions that providers enter to justify non-compliance.
In comparison to the present invention, in conventional EHRs patients have no way to register preferences for access to their EHR records by individuals in provider organizations or to audit such access. Conventional EHRs give providers no way to control, document or inform patients about the exchange of patient information outside their organizations as when they refer patients to consultants, transfer patients to other providers, or coordinate care with the patient's other current providers. To minimize liabilities associated with privacy breaches, providers equipped only with conventional EHRs minimize external information exchanges or place the burden on patients to convey information to other providers, inadvertently compromising the quality and safety of patient care.
Objectives.
The present invention is designed for use by patients, providers with and without EHRs, administrators, health information exchanges and health insurance payers as a means of optimizing care coordination and streamlining regulatory compliance without compromising the privacy preferences of patients.